Children Dying in Native Communities: Urgent Help Needed in Loreto, Peru

For the past four days, Olivia Bisa Tirko, president of the Chapra Nation, has been in Lima seeking help because children are dying in native communities in Loreto and no one pays attention to them. She has tried to communicate with the Ministry of Health, the Ministry of Culture or some authority that breaks the indifference that has meant that in a week the disease whose exact diagnosis they do not know has already caused five deaths and several dozen infections. No one has received it.

Also read: Dengue overwhelmed: what went wrong for Peru to suffer the worst peak of cases in recent years?

The Autonomous Territorial Government of the Chapra Nation is made up of 28 native communities located in the district of Morona, in the province of Datem del Marañón, department of Loreto. It is in the community of Shoroya Nuevo where five deaths have been reported between July 5 and 9: four children between 5 months and 4 years, and a 54-year-old adult. In addition, there are two other minors in serious condition. In the rest of the communities there are reports of the disease, but the figures are not yet clear.

It is also not clear what exactly the disease is. The first cases began a week ago with fevers, diarrhea with bleeding, pain and vomiting, symptoms that would indicate an Acute Diarrheal Disease (ADD). Masurashi Nochitamata, president of the Chapra del Morona Federation, was the one who contacted Olivia to warn about what was happening and, above all, to ask for help to mobilize those affected. The families of Shoroya Nuevo do not have the resources to evacuate the sick in a fast boat to the nearest health center, located in San Lorenzo, some eight hours away by river.

Loreto: they ask the Minsa for help after an increase in cases of diarrheal disease in children. (Photo: Chapra Nation)

“In the health post there is no equipment to diagnose the disease. There is only one nursing technician who has indicated that it would be a diarrheal disease, but there are no longer a few, there are deaths and there are 50 infected. President [Nochitamata] He called me because he had no backup. It started a week ago, but they’ve played it down. In the Health Network they say that they cannot send brigades because they do not have a budget”, the leader explained to El Comercio.

different causes

In Peru, EDAs are an important cause of morbidity and death in children under 5 years of age. There are three types (watery diarrhea, dysentery, when there are traces of blood, and persistent, which can last more than 14 days) and can be caused by different pathogens ranging from viruses, bacteria, fungi or parasites.

Determining the cause is crucial. Being a disease that is transmitted by contact with fecally contaminated water or food, Theresa Ochoa, a pediatric infectologist and director of the Alexander Von Humboldt Institute of Tropical Medicine in Cayetano Heredia, explains that it is important to study an outbreak to identify the source of contamination.

“If they have reported that there is blood, the group of pathogens is reduced and it would mainly be bacteria and some parasites. If there is no blood and the children have died from dehydration, we would be talking about a virus, such as rotavirus, which is preventable with vaccination. The cause has to be identified, which can be food, water or a person who arrived in the area and is infecting others, ”he indicates to this newspaper.

Carlos Medina, an infectious disease doctor at Hospital Cayetano Heredia, agrees that it is essential for the Ministry of Health (Minsa) to identify the source to determine the actions to be taken. Although EDA due to a virus does not have a specific treatment, if it is a bacterial agent there is antibiotic therapy.

“If it is viral, the most important thing is hydration support. The Minsa has to frame which population is being affected. Identify the age group, differentiation by sex or some specific characteristic, take samples to see which agent is causing it”, he adds.

Yesterday, after Olivia Bisa Tirko appeared on Canal N, the Ministry of Health (Minsa) confirmed that there is an “unusual increase” in cases of EDAs in the Yankuntich community, Morona district, on the border with Ecuador. For this reason, yesterday an Outbreak Rapid Response Team (ERR) from the Datem del Marañón Health Network traveled to the area and another trip of specialists from Geresa Loreto is planned for today with the support of a Peruvian Army helicopter .

“The team will carry out the epidemiological investigation of the event through the active search for cases, sampling and implementation of prevention and control measures. Depending on the state of health, patients who require care will be evacuated to the hospitals of Loreto or Lima,” they said in a statement.

“During the pandemic my people were dying from covid and now they are dying again and it is not known why”

Olivia Biza, President of the Autonomous Territorial Government of the Chapra Nation (GTANCH)

However, the indigenous leader points out that the Minsa statement speaks of another community that is also presenting cases, but that is far from the point where there are already fatalities. In fact, one of the requests is that this problem be addressed as a whole and all the affected areas can be identified, although with priority where there are serious cases that require immediate evacuation for attention.

“Yankuntich is on the border with Ecuador, in the original Achuar people and the constant deaths are taking place downriver, in the Chapra Nation, eight hours away by river. They are different peoples. They are responding to a place that also has the symptoms, but not with the Chapra people who are dying,” he says.

Olivia asks that it be quickly identified what disease it is. They fear it could also be leptospirosis, a zoonotic disease caused by a bacterium called leptospira. The main contagion occurs through direct contact with the urine of infected animals or with an environment contaminated by urine. They have this theory because in the neighboring communities of Ecuador there are reports of the presence of this infection.

overflow risk

It is not the first EDA outbreak so far this year. Already at the beginning of 2023, there was a warning of a dangerous increase in the Tumbes region. According to the National Center for Epidemiology, Prevention and Disease Control (CDC Peru) for February 982 cases were reported20 of whom were hospitalized, with a rapid increase that went from 2 cases reported on February 18 to 149 only on the 21st of that month.

At that time, the CDC indicated that the heavy rains had caused the cutoff of drinking water, so that “families in the area of ​​the outbreak had to get their water supply through tanker trucks.” The analyzes taken then identified rotavirus as the main pathogen.

According to Medina, in most cases diarrhea in children has a viral origin: “A vaccination sweep is needed because if there is any germ circulating in that area, any defenseless child is at greater risk of becoming infected and causing severe disease.”

However, vaccination against rotavirus is at low levels. While at the national level it reaches 40.6%, in Loreto the scope is even lower: only 31% of children vaccinated this year.

At the national level, the CDC Peru reports 617,074 episodes of ADD and 32 deaths until the end of June. It is almost double that registered in the same period of the previous year, when there were 384,742 cases and 7 deaths.

After the health catastrophe caused by COVID-19 in Peru and the dengue epidemic treated with delays, is there a risk that this disease could get out of control? Ochoa maintains that it is, especially in a context of temperatures above normal due to the presence of the El Niño Costero phenomenon. “There is risk. Diseases are among the health problems due to floods and rains. It is important that progress is made with the rotavirus vaccination but also against measles, because children can have a severe complication due to bacteria that cause diarrhea ”, he warns.

If rotavirus vaccination is low, measles vaccination is even lower. The Single National Repository of Health Information (Reunis) reports that from January to June of this year there are only 29.4% of 18-month-old children with the second dose of measles vaccine. In Loreto it is worse: 23.7% vaccinated.

Meanwhile, in the Chapra Nation they have more worries. According to Olivia Bisa, the Inca Roca and Wayusa communities have reported an accelerated increase in bat attacks. “We need them to urgently vaccinate against wild rabies, there are already several attacked, most of them are minors,” she says. Until the closing of the note, she was not received in any ministerial office.

PREVENTION

Transmission occurs through contact with contaminated food or water.

Frequent hand washing with soap and water or gel alcohol, especially before eating, before preparing food, after changing diapers and after going to the bathroom. Hands carry many viruses and bacteria that cause diarrheal diseases. Boiled water consumption is recommended. If you do not have it, place two drops of 5% commercial bleach per liter of water. Let stand 30 minutes before using. Consume food in good condition. Check the expiration date. Wash the vegetables. Add a teaspoon of bleach for every liter of water and let it rest for 30 minutes, then rinse it with cold boiled water. Complete the national vaccination scheme
2023-07-12 19:33:39
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